PC 707 Module 6 Exam - Respiratory & ENT Q & A What are peak flow readings? -measures amount of expelled air (Liters/minute) -this is an important tool
... [Show More] for asthmatics to use in order to determine when to use their SABA or when to seek help* -part of the asthma action plan monitoring system* If using a metered dose inhaler and 2 doses are needed, how long must you wait in between inhalations? -at least 1 minute What SABA may be as effective as albuterol with less side effects? -levalbuterol (Xopenex) -more expensive* -do not use children <4years old or in lactation* Chronic inflammation from asthma can lead to: -airway remodeling which could result in COPD* Why is it extremely important to educate patients on the difference between SABA & LABA for those who need to use both? -a patient could die if they accidentally reach for their LABA during an acute attack* What is the black box warning with LABA? -increases risk of asthma related death -contraindicated if not using another long-term maintenance medication* -this is due to patient accidentally reaching for LABA in acute asthma attack—having a fixed dose combo of ICS & LABA reduces this risk*. -can also cause death due to LABA having no anti-inflammatory effect so when used alone—inflammation continues and airway remodeling occurs When are LABAs used? -as an additional therapy if ICS are not enough* -helps to achieve prolonged/sustained bronchodilation--as maintenance -do NOT use LABA as monotherapy--patient must also be on inhaled steroids* What are the side effects of both SABA & LABA? -nervousness, shakiness, tremor, palpitations ICS for asthma: -decreases inflammation -does NOT provide immediate relief--need a SABA for this* -can be given via an inhaler or nebulizer -Ex: beclomethasone, budesonide, flurisolide, fluticasone (Flovent HFA), triamcinolone (Azmacort) What is Advair Diskus? -fluticasone (ICS) with salmeterol (LABA) -easier to use for patients who need this combination* -no concern with confusing their SABA vs LABA* Can ICS use in children effect growth? -potential to "stunt" growth in the 1st year of use--however it does not impact their expected height as an adult* Side effects of ICS: -oral candidiasis -dysphoria -HPA axis suppression -glaucoma Side effects of ORAL steroids: -H/A, dizzy, sleep difficulty, inappropriate happiness, severe mood swings Why are mast cell stabilizers not an initial treatment for asthma? -takes several weeks for full effects to be noticed* -need to take 3-4x a day--decreasing adherance -S/E-->nasal irritation, cough, sneezing -Ex: nedeocromil (Tilade) & cromolyn (Intal) -works better in children than adults Besides the dangerous side effect of behavior changes such as aggression and Suicidal ideation--what other potential side effects of leukotriene modifiers/antagonists? -H/A, stomach pain, heartburn, upset stomach, Nausea, diarrhea, tooth pain, dizziness, fever, stuffy nose, sore throat, hoarseness Who should avoid methylxanthines? -patients with hx seizures, HTN, CVA Side effects of methylxanthines? -stomach upset, heartburn, insomnia, H/A, nervousness, irritability, tachycardia, tachypnea What is the primary use of anticholinergics/antimuscarinics in asthma? -used for emergency situations* -Ex: ipratropium bromide (Atrovent) -S/E--->H/A, dry mouth, hoarseness, cough, stuffy nose, sinus pain, nausea -more routinely used in COPD* What blood level should be expected for a therapeutic effect from theophylline? -12-15 -this is near toxicity--need to monitor closely! Why is an asthma spacer encouraged? -increases delivery of drug to the lungs -minimizes risk of oral thrush -makes it easier for the patient to use What is dupixent (Dupilumab)? -a new asthma drug -monoclonal antibody* -used for moderate-severe asthma -only for >12 years old -injection* -IgG antibody---so potentially could cross placenta and cause risks to fetus* -potential for immune type reactions What are the risks of uncontrolled asthma in pregnancy? -pre-eclampsia -preterm delivery -low birth weight -fetal growth restriction -perinatal mortality ---->more risks with uncontrolled* What is the preferred SABA in pregnancy? -albuterol What is the first line for persistant asthma in pregnancy? -ICS -budesonide is preferred* --->if a patient is well controlled on a different medication--it is best to let them continue it* Asthma medications with breastfeeding? -most medications are safe -albuterol & budesonide are safe--low bioavailability and minimal amount is excreted into the breastmilk Theophylline with breastfeeding: -should be avoided if possible -increased risks and interactions -potential hyperstimulation & disrupted sleep in the infant -if it is absolutely needed, breastfeeding should still be continued* -try to breastfeed before medication and wait 2-4 hours after to breastfeed again [Show Less]